In The End of October, published early in the present pandemic, Lawrence Wright initially appeared to be not only a novelist, but also a prophet. Before the virus now known as COVID-19 made a crucial mutation, while it still predated primarily on bats, pangolins, and other wild animals in the south of China, Wright envisioned a deadly pandemic that throws the world into chaos. But as prescient as it might seem, Wright’s novel stems more from careful research than from mystical insight. An award-winning journalist, he consulted diverse experts in epidemiology, veterinary medicine, and viral immunology, as well as scientific journalism and global-health storytelling. And the novel eventually reveals that the most important question is not how he predicted 2020 so accurately, but why most of us did not—why we, unlike him, failed globally to identify the correct narrative.
Wright’s virus first takes hold in concentration camps in Indonesia, rather than in the markets of Hunan. Yet Wright accurately predicts much of the real-world biological, economic, and political fallout that will characterize 2020 in the history books. His fictional “Muslim disease” and rumors of bioterrorism presage our own racist moniker of “the China virus” and rumors of its laboratory origins. Meanwhile, the fictional health advisor for the United States government, Lieutenant Commander Bartlett, complains of the lack of resources and personnel, explaining that “People are dying of other treatable diseases because we have no stockpile of essential medicines. They’re all made in India or China, which are also suffering this pandemic. We’re running out of syringes, diagnostic test kits, gloves, respirators, antiseptics, all the stuff we need to treat patients and protect ourselves.” Her fictional words mirror those of an April 2020 report in The New England Journal of Medicine: “There are not enough ventilators for patients with COVID-19 in the upcoming months. Equally worrisome is the lack of adequate PPE for frontline health care workers, including respirators, gloves, face shields, gowns, and hand sanitizer . . . The U.S. shortage has multiple causes, including problems with the global supply chain.”1 Bartlett also predicts: “There will be runs on the stores. Pharmaceuticals, groceries, batteries, gas, guns, you name it.” While Wright doesn’t specifically mention toilet paper, his description feels real. He accurately portrays the eventual complacency of the American public after the first wave of deaths recedes, noting that “people were returning to work, filling up restaurants, and flocking to theaters and sporting events. They stopped wearing respirator masks, drinking in the air that had just recently been so treacherous.” And he depicts the return of a second wave that once again decimates the population.
Wright even seemed to have an eerie foreknowledge about how the Trump administration would respond to such a pandemic. While he tactfully names no one, he writes of a president “who appeared deeply tanned, either from extra sessions in the tanning bed or an extra-heavy layer of pancake,” who embraces martial law and who fires people “for being too frank on the subject” of Russia. Meanwhile, the vice president is “a former governor and radio host” with blue eyes and “evangelical piety,” who, after the president succumbs to the disease, attempts to lead the country with an intense moral ideology that is unequipped to deal with the harsh realities and ethical quandaries of international politics. The Trump and Pence of this alternate universe bear a canny resemblance to our own: “Commentators on FOX were applauding the forceful actions of the administration for stopping the disease, citing the much-criticized travel ban,” while the vice president urges everyone to go back to work, and the president himself is “almost entirely absent in the debate about how to deal with the contagion, except to blame the opposing party.”
How could Wright have accurately predicted so much? The answer may partially lie in the history of disease narratives, which he extensively studied, and particularly in the development of germ theory in the late nineteenth century. The experiments of Louis Pasteur, Edward Jenner, Robert Koch, and others showed the world that communicable disease was caused by tiny biological particles, germs that could be isolated in laboratories and traced from host to host. Before germ theory, nobody knew exactly what caused disease or how it traveled. Germs finally provided an unambiguous reason for why we get sick. Get rid of germs and we get rid of disease. The discovery led to a host of medical innovations, including the use of antibiotics and many of our current vaccines.
But the triumph of germ theory also severely delimited how people account for the spread of disease, bracketing off almost entirely the complex, interrelational explanations about the spread of disease that preceded germ theory. For example, Dr. Thomas Bevill Peacock, physician for diseases of the chest at the Royal Hospital and the City of London Hospital writes in 1848: “The precise nature of the cause or causes of the epidemic of Influenza, we must . . . regard as involved in the obscurity that veils the origin of epidemics generally. There can, however, be no doubt, that the more common predisponents to disease, such as defective drainage, want of cleanliness, overcrowding, impure air, deficient clothing, innutritious or too scanty food, etc, powerfully conduce to the prevalence and fatality of the affection.”2 Dr. Peacock embraced miasma theory, which was the dominant theory of disease prior to the discovery of the germ. Miasma theory was based on the idea that disease came from “bad air,” but that many other factors contributed to both the creation of miasma and the susceptibility of individuals to miasma. While Dr. Peacock did not know the exact biological mechanisms of disease, he and his colleagues recognized that the deadliness of an epidemic seemed to depend upon economics, cleanliness, and morality. Many aspects of human life and human choices contributed to the creation of disease.
The appeal of the germ theory narrative lies in its streamlined simplicity. One cause (germs) leads to one effect (disease). Yet this narrative occludes much of the messy complexity of disease, and the problem is that germ theory still dominates much of the current rhetoric about epidemics. The genre of the realist novel, which can contain multiple plot lines, various character and narrator perspectives, and diverse contexts, may be the antidote to the blind spot hidden within science textbooks and medical articles in this current age of germ theory. Wright’s novel capitalizes on all the potential of the genre to show that its virus is a logical consequence of multiple current world circumstances. Wright is not a prophet, but rather an expert at seeing the connections between phenomena occurring in different contexts and on different scales. He describes the vast complexities and contradictions of international politics at the same time that he explores the minuscule world of viral genetics and the mechanisms of disease transmission. And he pointedly illustrates the ties that bind these microscopic and macroscopic worlds together, revealing that the biological is always also political.
Near the beginning of the novel, Wright describes the scene as his main character, Henry, a renowned epidemiologist, lands in Indonesia:
From the air, Henry could see blazes in Sumatra. The native forests and peatland were being torched to make way for more palm plantations. They supplied the oil used in about half the packaged products found in supermarkets, from peanut butter to lipstick. Each year, smog from the fires blanketed Southeast Asia, killing as many as a hundred thousand people in some seasons, and pushing global warming to a tipping point. As soon as Henry stepped outside the Jakarta airport and stood in the taxi queue, the heavy air scorched his nostrils. He looked at the masses of travelers coming and going and thought: Asthma, lung cancer, pulmonary disease, each inflicting its own cruel method of death. He had a professional habit of seeing pathology wherever he turned.
A desire for lipstick results in climate change; a peanut butter sandwich causes cancer. These statements, read by themselves, are not intuitive. But Wright’s tightly crafted narrative includes precisely those facts necessary to trace the chains of causation from Indonesia to our local supermarket and from individual choice to global catastrophe.
Out of the infinite data we generate, choosing which facts are important is a skill essential to both fiction-making and science, because both fields depend on narrative, which tracks the links of cause and effect over time. Henry later illustrates his own kind of narrative-making while deep in the bowels of the ocean in a submarine with an increasing number of infected crewmembers. In his desperate attempt to save the remaining submariners, and “cut off from the array of sophisticated laboratory devices available to twenty-first-century medicine, Henry had to take himself back in time, hundreds of years, to a period before the great vaccines of the twentieth century countered the scourges of the past.” Bereft of microscope and petri dish, Henry relies on a store of knowledge and methodologies that had successfully combatted infectious disease before the advent of germ theory. He pieces together various facts about disease: Louis Pasteur’s botched experiment with chickens, fifteenth-century Chinese medical practices, the inoculation of John Adams and his family. He finally comes up with a way to immunize the crew by seeing the connections between a number of seemingly unrelated facts from widely different contexts. In the literary world, this is called creating a narrative, while in the scientific world, it is called creating a hypothesis. However, in the cramped quarters of an isolated submarine, and without the luxury of creating a second hypothesis if his first experiment fails, the narrative choices that initiate the scientific method are paramount.
Wright’s descriptions of the intricate connections between minute chemical reactions and giant global changes, historical events and current crises, resemble a line of thought that is gaining momentum in the real world. “One Health,” an interdisciplinary methodology used to approach many of the world’s problems, emphasizes the connections between human, animal, and environmental health.3 The scientists who embrace One Health may not realize it, but the methodology also combines the best parts of germ theory and the miasma theory that preceded it. Like conventional germ theory, it embraces facts derived from the sterile laboratory. However, it also contextualizes them within the realms of economics, policy, and culture—a practice that hearkens back to miasma theory. The approach has gained increasing attention as the number of outbreaks of zoonotic diseases has increased. For example, the Journal of Ethnobiology and Ethnomedicine recently published an article tracing the outbreak of COVID-19 back to two main human behaviors: “The encroachment of human activities (e.g., logging, mining, agricultural expansion) into wild areas and forests and consequent ecological disruptions” and “the commodification of wild animals (and natural resources in general) and an expanding demand and market for wild meat and live wild animals.”4 The new interactions between previously isolated wild animal populations and humans create the perfect circumstances for the spread of zoonotic disease. As the article concludes, COVID-19 is “a creature of the Anthropocene” created through its main traits of “ecosystem and biodiversity loss, disrupted and turbulent ecologies, pervasive human activity, intensification of land use, commodification of traditional foods and knowledge.”
Like Wright’s fictional narrative, these real studies show that a deadly pandemic is a predictable consequence of a complex stew of global warming, mass consumerism, political ineptitude, and basic biological functioning already existing in the world. However, the complexity of the factors leading to the outcome of a pandemic calls for the construction of a nuanced, informed narrative that can isolate exactly those details that are most relevant. Wright’s predictive skill demonstrates that we do have the ability to create such narratives, and the One Health methodology reveals that some are actively doing so by attending to those details that are so often overshadowed by medical accounts of contact tracing, laboratory settings, and new vaccines—all narratives that gained prominence with the acceptance of germ theory.
Yes, isolating, studying, and disabling the virus will play a crucial role in ending the COVID-19 epidemic, just as it does in fighting the virus of Wright’s novel. However, The End of October reminds us that such strategies are only stopgap measures as long as we fail to recognize a bigger, messier story, one that implicates us all in the propagation of complex environmental, economic, and political conditions that give rise to disease in the first place. The epiphany that ends Wright’s novel is actually one that we knew centuries ago: “We did this to ourselves.”
1. Megan L Ranney, et. al. “Critical Supply Shortages—The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic.” The New England Journal of Medicine 382, no. 18 (2020): e41.
2. Thomas Bevill Peacock. On the Influenza or Epidemic Catarrhal Fever of 1847–8. London: John Churchill, 1848. Dr. Peacock writes this book in the wake of the 1847 influenza epidemic in London and attempts to provide his comprehensive observations as well as some speculation about the nature and cause of the disease.
3. Peter MacGarr Rabinowitz, et. al. “A Planetary Vision for One Health.” BMJ Global Health 3, no. 5 (2018): e001137.
4. Gabriele Volpato, et. al. “Baby Pangolins on My Plate: Possible Lessons to Learn from the COVID-19 Pandemic.” Journal of Ethnobiology and Ethnomedicine 16 (2020).